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New guidelines make Medicaid availability grow

Client Specialist Vicky Fritz, at the Hilltop Program B4 Babies and Beyond, at the Workforce Center at 29 Road and North Avenue can determine eligibility for patients for Medicaid and Colorado Health Plan Plus in one visit and issue a temporary card.

Eligibility requirements for Medicaid recipients will widen next week, thanks to a new state health care law that required contributions from hospitals.

The Colorado Health Care Affordability Act, which goes into effect today, allows some 67,500 more Coloradans to gain access to Medicaid insurance either through Colorado’s Health Plan Plus or Medicaid benefits for parents with at least one child on Medicaid.

Previous income guidelines were $45,207 for a family of four, but those have increased to an annual income of $55,125 for a family of four. Parents in a family of four without children on Medicaid can make up to $22,000 per year to qualify.

“Come in and apply,” urged Cathy Story, director of Child and Family Center, 2897 North Ave. “Don’t guess if you’re eligible. Don’t miss out on that opportunity to come in and try to get insurance if your kids are uninsured.”

Hilltop’s B4 Babies & Beyond program is the only place in Mesa County where families can get presumptive eligibility, or nearly immediate Medicaid coverage, if parents qualify under income guidelines. Parents need birth certificates, documentation of the last 30 days of work and photo identification. Parents can qualify presumptively for insurance, while working to obtain a birth certificate, Story said.

“(The new law) is costly, but it’s not more costly than if we don’t do anything,” Story said about the prospect of fewer people entering emergency rooms without insurance or pregnant moms putting off prenatal care.

“It’s a good thing for kids and families, and it really does impact the working poor.”

According to the State Department of Health Care Policy and Financing, the new law will allow an additional 1,505 children and 1,432 parents to be eligible for Medicaid or the CHP+ benefits on the Western Slope.

Funding for the new health care legislation is derived from fees collected from hospitals around the state. Those fees are assessed by a complex formula that weighs a hospital’s amount of indigent care and its types of care.

The federal government matches those fees in a move expected to create a $1.2 billion surplus. The funds are reallocated to hospitals according to the amount of charity care hospitals offer and according to which hospitals serve the most Medicaid patients.

St. Mary’s Hospital, for example, earned $580,000 under the formula.

It counted 10,838 Medicaid patient days in 2007. One day is equal to a 24-hour hospital stay for one patient on Medicaid. Dan Prinster, St. Mary’s Hospital vice president of business development, said the hospital spends $3.5 million in charity care each month.

Community Hospital, conversely, lost money to the funding formula, but the hospital was reimbursed those costs through the Colorado Hospital Association, said Chris Thomas, the hospital’s president and chief executive officer.

“We have a lower Medicaid population primarily because we don’t deliver babies,” Thomas said.

“We are one of those 13 hospitals on the losing side.”

Community Hospital served 1,019 people with direct charity care, paying out $1.6 million. Its total charity care and bad debt, or unpaid bills, is $12.6 million, Thomas said.

“This is good for Coloradans,” he said. “Across Colorado, this allows more patients to get Medicaid and get matching funds. Even though we’re neutral, we’ll see benefits if there are more Medicaid patients, even though Medicaid doesn’t pay hospitals well.”

Nearby hospitals such as Valley View Hospital in Glenwood Springs earned back nearly $1.3 million, and Grand River Medical Center in Rifle earned back $703,000.

Fruita’s Family Health West paid in $25,000 and earned back $9,000, losing $16,000. Family Health West’s new hospital opened in July.

By 2012, the fees also will allow Medicaid to expand to include 80,000 more adults who don’t have children. The effort should help the state meet a federal mandate to increase by 2014 the Medicaid eligibility to those who are 133 percent of the poverty level.